being a one

there is only one year in your life that you can be a one, and this is my year.  i hear that as a two your experience is very different.  and a three?  that feels so far away i cannot even imagine it.  so here's how it works:  

you graduate med school, get a new plastic ID badge, a new pager, and everyone starts treating you differently.  you know roughly the same amount you knew as a 4th yr medical student, but now you get questions like "what you want to do about ms. X's blood pressure?"  "why is mr. Y tachycardic?"  "would you intubate this patient for me?" (a neurosurg attending asked me that the other day).  when you're a student the questions are more like this: "would you move out the way so i can take care of this patient?"  "would you stop asking questions so those of us who work around here could do our jobs?", or "go do a rectal on room 12"  ok, that last one was never a question.

i don't mind it.  actually in some ways i love it.  from the outside, a lot of people think hey you're a doctor so you must be an expert on everything going on with my body.  from the inside, i.e.  nurses who have practiced longer than i've lived, they must be thinking who is this hotshot kid?  more people than i can count have asked me this year if i've ever heard of doogey hauser.  yes, yes i have.  

so what i love about it is that you really are innocent until proven guilty.  if you know what you are doing, if you do a good job, as long as you don't kill anyone, most people in the hospital just back off and let you roll.  there are checks and balances of course, but still you could do a lot of good or a lot of harm.  i think what that fact does for me is it drives me back to the text, because i don't want to get it wrong and have a bad outcome for my patient.  also i love the sense of urgency, the right-now decisions.  its part of why i went into emergency med.  when i'm on call in the ICU, i am certainly not the most qualified person to make a decision.  the patient may be better off having a sec0nd-year make that call, or a 5th yr, or a fellow, or ultimately, an attending.... but i'm the one who's there at the bedside.  they know the literature, but i know the patient.

making mistakes is a part of life.  and certainly a big part of being an intern.  as far as i can tell, the function of teaching faculty is to let you learn from mistakes, and at the same time keep your from killing anyone.  and while making mistakes is natural, not learning from mistakes is fatal.  i've got another 2 1/2 yrs of more experienced docs looking over my shoulder, then it's gametime.  i can honestly say that at this point in my medical journey, i appreciate having people check me out in the sense of "why did put in that line?"  "why that antibiotic?"  because if i have no good answer to that question, then seriously, wth am i doing??  

my favorite question that attendings ask, mostly in the ED, is "so, what do you want to DO?" after i've spelled out what i think is wrong and why, it is the next logical question.  to act, and to act rightly, and to act quickly, is for me what it means to be a good doctor.  it is our actions that make patients well.  it is also our actions that can harm patients.  but, given the choice, i'd rather act more than less.   there are cases where no action is required.  those are the cases i hate.  i want to do something.  

this is a brief view of what it is like for me to be an intern.  i love what i'm doing right now. tonight, before typing this, i was watching a vascular interventional radiologist place a coil in the aneurysm of a girl who has blood on her brain.  without that coil, she would die.  it was such a rush.

if you've never watched the show "scrubs", rent season one.  it is the most accurate TV show about life in the hospital.  at least i think so.